Early ADAMTS13 testing associates with pre-eclampsia occurrence in antiphospholipid syndrome. Issue 203 (July 2021)

• Record Type: Journal Article
• Authors: Bitsadze, Viktoria; Bouvier, Sylvie; Khizroeva, Jamilya; Cochery-Nouvellon, Éva; Mercier, Éric; Perez-Martin, Antonia; Makatsariya, Alexander; Gris, Jean-Christophe
• Is Part Of: Thrombosis research. Issue 203(2021)
• Page Start: 101
• Page End: 109
• Publication Date: 2021-07
• Subjects: Antiphospholipid syndrome -- Pregnancy -- ADAMTS13 -- Pre-eclampsia -- Placenta; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2021.04.021
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: Women with obstetric antiphospholipid syndrome (oAPS) still develop placental diseases, mainly pre-eclampsia (PEcl), which diagnosis is associated with reduced ADAMTS13 levels. Testing ADAMTS13 in newly pregnant oAPS may provide evidence for risk stratification. Materials and methods: We retrospectively investigated the prognostic value of ADAMTS13 activity, antigen and antibodies on stored plasma samples obtained prior to beginning low-molecular weight heparin-low dose aspirin treatment in 513 oAPS women. Results: Some women had evidences of early positive ADAMTS13 antibodies and low ADAMTS13 activity:antigen ratio, suggestive of ADAMTS13 dysfunction. Women with a subsequent PEcl had higher ADAMTS13 antibodies ( p < 0.0001), and lower ADAMTS13 activity and activity:antigen ratios ( p < 0.0001). In multivariate analysis, these markers were significant risk factors for PEcl and for the most devastating PEcl subgroups (early-onset PEcl, severe PEcl, PEcl with no living child after 28 days). ADAMTS13-related markers showed acceptable discrimination power to predict clinical events, particularly for ADAMTS13 activity:antigen ratio in predicting PEcl cases with no living child after 28 days (AUC: 0.844 (0.712–0.974), p < 0.0001), with excellent negative predictive value (0.990). Conclusions: The characterization of ADAMTS13 in newly pregnant women with oAPS depicts the risk of PEcl occurrence. ADAMTS13 might help identify pregnant women with oAPS not requiring escalating treatment strategies to prevent PEcl. Graphical abstract: Unlabelled Image Highlights: Women with obstetric antiphospholipid syndrome (oAPS) still develop pre-eclampsia. Pre-eclampsia (PEcl) is associated with reduced ADAMTS13 levels. We tested the prognostic value of ADAMTS13 in 513 oAPS women prior to treatment. ADAMTS13-related markers predict PEcl with an excellent negative predictive value. ADAMTS13 might help identify pregnant oAPS women at low risk of PEcl.